/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/,

/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/name-97279-en.cckm

201712356

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Inpatient Delegation Protocols

Asthma or Wheezing - Adult/Pediatric - Inpatient/Emergency Department [3]

Asthma or Wheezing - Adult/Pediatric - Inpatient/Emergency Department [3] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols



Protocol Number: 3

Delegation Protocol Title:
Asthma or Wheezing – Adult/Pediatric – Inpatient/Emergency Department

Delegation Protocol Applies To:
Adult and pediatric inpatients and Emergency Department patients

Target Patient Population:
Adult and pediatric inpatients

Delegation Protocol Champion:
Kristin Shadman, MD – Department of Pediatrics – Hospitalists
Joshua Ross, MD – Emergency Medicine - Pediatric

Delegation Protocol Reviewers:
Daniel Jackson, MD – Department of Pediatrics – Allergy
Sima Ramratnam, MD – Department of Pediatrics – Pulmonary
Jonathan Fliegel, MD – Department of Pediatrics – Hospitalists
Scott Hagen, MD – Department of Pediatrics – Intensive Care Unit
Andrew Lee, MD – Emergency Medicine
William Busse, MD – Department of Medicine – Allergy
Loren Denlinger, MD – Department of Medicine - Pulmonary
Rhonda Yngsdal-Krenz, MBA, RRT-NPS – Respiratory Care
Christine Hellenbrand, RT – Respiratory Care
Peter Rusch, RT – Respiratory Care

Responsible Department:
Respiratory Care

Purpose Statement:
To delegate authority from the provider caring for the patient’s asthma or recurrent wheezing to
Respiratory Therapists (RTs) to place orders for treatment of asthma or recurrent wheezing.

Who May Carry Out This Delegation Protocol:
Respiratory Therapists (RTs) who have been trained in the use of this protocol.

Guidelines for Implementation:
1. The protocol is activated when the provider places an order for:
1.1. Pediatric patients: “Initiate Pediatric Asthma or Wheezing Protocol ”
1.2. Adult patients: “Initiate Adult Asthma or Wheezing Protocol”
2. Inclusion Criteria – Pediatric patients
2.1. Diagnosis of asthma or a history of recurrent wheezing
2.2. Patients with first time wheezing that have demonstrated responsiveness to albuterol
suggesting initial presentation of reactive airway disease
2.3. FiO2 < 50%
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org



2.4. Patient exhibits one or more of the following symptoms:
2.4.1. Persistent cough
2.4.2. Dyspnea
2.4.3. Chest Pain
2.4.4. Wheezing
3. Inclusion Criteria – Adult patients
3.1. Diagnosis of asthma
3.2. FiO2 < 50%
3.3. Patient exhibits one or more of the following symptoms:
3.3.1. Breathless at rest
3.3.2. Agitation or confusion
3.3.3. In need of oxygen to keep SPO2 >92%
3.3.4. Diffuse wheezes or poor air movement without wheezes
4. Exclusion Criteria (Inpatient Only): If patient has met any of the following exclusion criteria the
protocol will not apply. The RT will contact the provider for additional direction.
4.1. Any patient on adjunctive therapies
4.2. Patients with an FiO2 > 50%
4.3. Patients with a concomitant diagnosis including:
4.3.1. Cystic Fibrosis or other chronic lung disease
4.3.2. Congenital or acquired cardiovascular disease
4.3.3. Bronchopulmonary dysplasia
4.3.4. Immunodeficiency syndromes.
5. The RT receives a page for protocol initiation.
6. The RT will follow the appropriate population-specific Asthma or Recurrent Wheezing algorithm.
7. The RT will assess the patient.
8. As outlined in the treatment algorithm, the RT will use the results from the assessment to determine
specific actions including placing orders for medications as indicated in the Diagnosis and
Management of Asthma – Pediatric/Adult – Inpatient/Ambulatory – Clinical Practice Guideline,
oxygen therapy, and pulse oximetry (if not previously ordered). Reassessment may be completed at
any time.
9. The RT will reassess the patient and modify/discontinue orders. The RT will treat the patient
between assessments if necessary following the appropriate treatment algorithm.

Order Mode: Protocol/Policy without cosign

References:
1. Welsh KM, Magnusson M, Napoli L. Asthma Clinical Pathway: An Interdisciplinary Approach to
Implementation in the Inpatient Setting. Pediatr Nurs. 1999 Jan-Feb:25(1):79080, 83-87.
2. Banasiak NC, Meadows-Oliver M. Inpatient Asthma Clinical Pathways for the Pediatric Patient:
An Integrative Review of the Literature. Pediatr Nurs. 2004 Nov-Dec;30(6): 447050.
3. Guidelines for the Diagnosis and Management of Asthma (EPR-3). National Heart, Lung, and
Blood Institute. http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines

Collateral Documents/Tools:
1. Diagnosis and Management of Asthma – Pediatric/Adult – Inpatient/Ambulatory – Clinical Practice
Guideline
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org



2. Asthma Exacerbation – Inpatient (Pediatric) Algorithm
3. Asthma Exacerbation – Emergency Department (Pediatric) Algorithm
4. Asthma Exacerbation – Inpatient (Adult) Algorithm
5. Asthma Exacerbation - Emergency Department (Adult) Algorithm
6. IP – Asthma Exacerbation – Pediatric – Admission Order Set [997]
7. IP – Status Asthmaticus – Intensive Care – Pediatric – Admission [5592]
8. IP – Asthma Exacerbation – Adult – General Care – Admission [1525]
9. IP – Asthma Exacerbation – Adult – ICU/IMC – Admission [1524]
Approved By:
UWHC Respiratory Care Committee: 2012, July 2015
UWHC Pharmacy & Therapeutics Committee: 2012, August 2015
UWHC Medical Board: 2012, October 2015

Effective Date: October 2015

Scheduled for Review: October 2017



Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org